I have had a surgery done on my right index finger (top of the
knuckle). The doctor used non dissolvable stitches. Then he left for
Europe and I have removed them by myself. Well... 95% of them. During
the removal small part of the tread disappeared under the skin. I was
not able to retrieve it. I estimate the length to be between 1/4 and
1/8 of the inch (black thread, feels like nylon). So here is my
question. Will non dissolvable stitches (or parts of them) dissolve
eventually and what are the possible risks? I will use your answer for
information purposes only so do not be afraid to answer. Thank you in
advance.

g00gle_answers_user,,,

I hesitated to post this as an answer, since after considerable
searching, about the only page I can find is a reference to
a lawsuit (which wasn't won, by the way) in which a doctor
is sued for having left non-dissolvable stitches in. The
result was that "one of the sutures had apparently eroded
through the skin and was causing a small degree of inflammation".
From the National Association of Personal Injury Lawyers site:
http://www.napil.com/PersonalInjuryCaseLawDetail36263.htm

This implies that the sutures will tend to work their way
out, much as a splinter might, and that they may cause
some inflammation in the process. Hopefully they would
retain sufficient integrity to then allow removal by way
of forceps or a similar instrument, but it should be 
considered that they may have tended to bond with the
surrounding tissue, and removal in this fashion might 
prove difficult and painful. They may also tend to lose
integrity, so that, short of compete dissolution, they
may fall apart when removal is attempted. Final removal
of the sutures in the case above was actually the result
of a second procedure.

Also to be considered is the possibility of a badly 
infected abcess related to the embedded sutures, which
would potentially require hospitalization and treatment
with antibiotics. Keeping the area clean is highly 
advisable, and the use of topical antibiotics, such as
neosporin, might be helpful.

It should be noted that the case was not won because the
patient had not requested an appointment from the Doctor
in her contact with him subsequent to the original surgery,
and her lawyers did not present an expert witness in the
process of presenting the case. Otherwise, the doctor
might have been found to be negligent.

It would seem to me that, if a physician is planning to
be unavailable for follow-up in a situation like this,
it is customary to refer cases which are pending to a
colleague. I would certainly contact his secretary or
answering service or anyone else in his office to see
if a referral can be obtained for an appointment where
the situation can be professionally assessed.


I apologize for the paucity of references in this answer,
but if you click on the numerous searches below, you'll
see that most of them produce no results whatsoever. I
also considered that you might prefer an answer sooner
than later.

Please do not rate this answer until you are satisfied that  
the answer cannot be improved upon by way of a dialog  
established through the "Request for Clarification" process. 
 
A user's guide on this topic is on skermit-ga's site, here: 
http://www.christopherwu.net/google_answers/answer_guide.html#how_clarify 
 
sublime1-ga


Searches done, via Google:

"non-dissolvable stitches" remaining
://www.google.com/search?q=%22non-dissolvable+stitches%22+remaining

"failure to remove" "non-dissolvable stitches"
://www.google.com/search?q=%22failure+to+remove%22+%22non-dissolvable+stitches%22

"neglected to remove" "non-dissolvable stitches"
://www.google.com/search?q=%22neglected+to+remove%22+%22non-dissolvable+stitches%22

"didn't remove" "non-dissolvable stitches"
://www.google.com/search?q=%22didn%27t+remove%22+%22non-dissolvable+stitches%22

"hadn't removed" "non-dissolvable stitches"
://www.google.com/search?q=%22hadn%27t+removed%22+%22non-dissolvable+stitches%22

"non-dissolvable stitches" "weren't taken out"
://www.google.com/search?q=%22non-dissolvable+stitches%22+%22weren%27t+taken+out%22

"non-dissolvable stitches" "aren't taken out"
://www.google.com/search?q=%22non-dissolvable+stitches%22+%22aren%27t+taken+out%22

"non-dissolvable stitches" "not taken out"
://www.google.com/search?q=%22non-dissolvable+stitches%22+%22not+taken+out%22

---

Request for Answer Clarification by g00gle_answers_user-ga on 02 Aug 2005 08:43 PDT

I was not asking for legal advice. I need to know about the materials
used in the procedure and what happens when they are not removed.

---

Clarification of Answer by sublime1-ga on 02 Aug 2005 14:19 PDT

g00gle_answers_user...

Thanks for your feedback. According to this article in
Wikipedia about non-absorbable sutures: 

"There are several materials used for nonabsorbable sutures.
 The most common is a natural fiber, silk, which undergoes
 a special manufacturing process to make it adequate for its
 use in surgery. Other nonabsorbable sutures are made of
 artificial fibers, like polyester or nylon. Finally, there
 are also metal wires used in orthopedic surgery because of
 their strength and in some other tissues because of the
 metal's outstanding tolerance by the body."
http://en.wikipedia.org/wiki/Suture


I quite understand that you are not seeking legal advice.
It's just that, as I said, there seems to be so little
information about stitches which have been left in longer
than normal that about the only references I can find have
to do with lawsuits from resulting complications.

Therefore I've done my best to extrapolate from these
rare references to determine what occurred as a result,
and what you might expect.


After another series of fruitless searches, I tried:

"stitches were left"
://www.google.com/search?q=%22stitches+were+left%22

This turned up another legal case in which failure
to remove stitches subsequent to an amputation caused
unspecified complications - presumably infection:
http://www.abc.net.au/7.30/content/2005/s1391146.htm


It also turned up a recent news story on AltaidAcheh.org
about caring for the Tsunami victims, in which a Doctor
reported:

"...patients could end up with septic wounds if the 
 stitches were left for too long especially since they
 did not have sufficient clean water for washing and
 cleaning."
http://www.altaidacheh.org/Update/40


It also turned up this bulletin board post in which a
man talks about stitches which were left in too long
subsequent to a facial plastic surgery procedure:

"He had plastic surgery on his face after his accident
 and his stitches were left in a bit too long (delayed
 for some reason) and they were "healed" into the scar
 so removing them caused a bit of bleeding and required
 a bit of tugging. But this is not typical and usually
 they just slip out with a little tug."
http://www.momay.fyz.com/archive/JunePlaygroup/msg/msg5945.htm


Yet another bulletin board post reports swelling due to 
stitches left in too long subsequent to wisdom tooth
surgery:

"...the stitches were left too long in my mouth and it
 was just like having a hair in there that i couldn't
 get out and then theres the swelling i looked as if
 i been in the ring with Tyson"
http://www.dogweb.co.uk/talk/dog1861-0.html


None of this significantly augments or detracts from
my original assessment of what is likely when stitches
are not removed in a timely manner, based on the first
reference I provided:

"This implies that the sutures will tend to work their way
out, much as a splinter might, and that they may cause
some inflammation in the process. Hopefully they would
retain sufficient integrity to then allow removal by way
of forceps or a similar instrument, but it should be 
considered that they may have tended to bond with the
surrounding tissue, and removal in this fashion might 
prove difficult and painful. They may also tend to lose
integrity, so that, short of compete dissolution, they
may fall apart when removal is attempted. Final removal
of the sutures in the case above was actually the result
of a second procedure.

Also to be considered is the possibility of a badly 
infected abcess related to the embedded sutures, which
would potentially require hospitalization and treatment
with antibiotics. Keeping the area clean is highly 
advisable, and the use of topical antibiotics, such as
neosporin, might be helpful."

To this I might add that, if the material does not tend
to work its way to the surface, allowing for eventual
access, the references I've provided would seem to 
indicate that it might become necessary to probe the
finger, with the use of a local anaesthetic, in order
to access the fiber, much as you may have done many
times with a needle in an attempt to remove a splinter
which is no longer accessible at the skin's surface.

With the further research I did, I am also less 
inclined to think that the materials used in 
non-absorbable stitches would lose integrity
when remaining in the tissue too long.


I believe this to be an accurate assessment, based on
what few references I have found, but obviously it is
not to be considered medical advice, and a professional
consultation is your best recourse.

If you believe my assessment is lacking something 
specific about which you have concerns, please let
me know what that might be.

sublime1-ga

1) Go to a doctor and have him examine your finger.

2) The next time you have sutures, if the doctor who put them in is
out of town, go to a different doctor, a walk-in clinic, or something
of that ilk to have them removed properly.

Cheers.

Thanks for not answering to the question. Please try to be more useful next time.

Cheers

Sorry, you're right.  I didn't answer the question, although I think
that my comment was, in fact, useful both to you and to anyone reading
this.  Nonetheless:

1) Non-dissolvable will not dissolve.

2) The risks of having them imbedded in your finger are:
  a) Infection: Any foreign body is a potential nidus for infection. 
This means that bacteria can find a haven there and propagate.  The
consequences of this are variable and likely not severe, but there's
always the possibility of a serious infection, which would suck ass. 
Antibiotics would have limited utility until the foreign body is
removed, as it will be difficult for them to penetrate into the suture
material itself.  Removal of the foreign body during an active
infection is more likely to have complications then when there is no
infection.
  b) Granuloma: often, your body will attempt to surround any foreign
material to isolate it from the rest of your body.  A suture granuloma
is a not-uncommon occurence in cases like this.  The consequences of
this range from a simple bump in the place where the remaining suture
material is, to a painful bump that aesthically displeasing and limits
the function of the hand (due to pain, or, depending on positition,
actually interferes with tendons).

These risks are likely small in this case, but you'd probably be
pretty upset if they happened.  Now refer to my first comment about
what to do about it, if you decide to have the problem fixed.

Cheers.

Oops.  That first risk should read:

Non-dissolveable SUTURES will not dissolve.

Cheers.

Thank you.

I'm sure you realize that linezolid-ga has no obligation to answer
your question. It's just a comment.

I had a similar situation to yours. After a minor surgery to have a
BCC removed from my arm, all of the stiches were supposed to dissolve.
Apparently there was an error made by the Dr. and non-dissolving
sutures were used instead. The stitches on the surface were easily
removed, but the ones internally slowly worked their way to the
surface causing inflamation and eventually an abscess that required
antibiotics.

My advice is to keep an eye on the area and don't hesitate to see a
Dr.,if there appears to be an infection. I waited a bit too long and
now have a nasty scar from it. Hope that you have better luck with
your finger.